Health care isn't free. It has a social cost. Someone has to choose between health care and other uses of money — deciding, for example, whether a procedure is worth the sacrifice of other goods and services that it would require.

Who should make these decisions? Under what circumstances do we want the decisions to be made by patients? When should they be made by insurance pools? And when should they be made by government?

New York Times columnist Nicholas Kristof implicitly asked these questions recently. Unfortunately, he got every answer wrong. Because many other people think the same way Kristof does, I'm going to devote this piece to his column.

Kristof wrote about his friend, Scott Androes, who was suffering at the time from stage four prostate cancer. Although he described his friend as "a victim in part of a broken health care system," nothing could be further from the truth. Androes was a middle class professional who decided not to buy health insurance because it was too expensive. As he developed symptoms, he chose not to see doctors and to avoid other expenses in order to save money. By the time he chose to seek care, he was in critical condition.

Kristof believes that ObamaCare would have prevented the tragedy if the new law had been in place. He's wrong about that too.

Let's start with the decision to be uninsured. I want to correct a few assumptions both Kristof and Androes seem to have made, because they are distracting. They imply that individually purchased insurance is more expensive than group insurance provided by employers. This isn't necessarily the case. For a healthy person, individual insurance is often cheaper. It may seem more expensive because the individual pays the cost directly.

But employer coverage isn’t “free,” as Kristof incorrectly implies. Because Androes worked as a part time consultant, he didn't have the opportunity to obtain employer coverage. That's understandable. But even if he had it wouldn’t have been free. Employer-paid premiums are a substitute for monetary wages. Whether through his work or not, the cost of insurance would have come out of Androes' pocket — not someone else's.

What is true is that federal tax law provides generous subsidies to employer-provided insurance, but gives little tax relief for insurance individuals purchase on their own. This policy encourages group insurance and discourages individual coverage. It encourages people like Androes to make the very decision he made. This tax policy is an inequity that my colleagues and I at the National Center for Policy Analysis have campaigned against for many years. But it is an inequity that is not — repeat, is not — corrected by ObamaCare.

Kristof believes that Androes cancer would have been caught earlier and his survival chances would have been greater if everyone were forced to have health insurance. But ObamaCare doesn't force everyone to have health insurance. The penalty for being uninsured is small, relative to the cost of the insurance. There is very little the IRS can do to enforce it. And the IRS has signaled that it doesn't plan on using a lot of resources to enforce the mandate anyway.

Countries like Britain and Canada actually do force people to have health insurance. Basically, it's provided to everyone and paid for by taxes that are not optional. But under ObamaCare, people like Androes will have a choice similar to the one they have today: They can obey the mandate and pay a hefty premium or they can save a lot of money by choosing to be uninsured.